An imbalance of the remodeling process for
bone resorption leads to a loss of tissue with consequent microarchitectural damage, evident in conditions such as
osteoporosis and related fragility fractures. Currently, pharmacological
therapies are able to prevent or slow down
bone resorption by inhibiting osteoclast activity. An innovative and targeted anti-resorptive approach is represented by the inhibition of
RANK ligand (RANK-L), essential for the proliferation and activity of osteoclastic cells. The human
monoclonal antibody against RANK-L (
denosumab) has been approved for the treatment of
osteoporosis. In clinical trials of patients with
osteoporosis, inhibition of RANK-L has reduced bone loss and damage to the microarchitecture and was associated with an increase in mass and resistance at different skeletal sites, with most significant effects than those demonstrated by any other
antiresorptive drugs. In addition, after 3 years of treatment, it showed a reduction in vertebral and non-vertebral fracture risk.
Denosumab treatment also has not revealed any alteration in the physiological processes of fracture repair, showing no increase in the onset of complications 3 years after the fracture. The data show that
denosumab offers an effective alternative therapeutic approach for the treatment of severe
osteoporosis, with positive effects on BMD and reduction of fragility fractures risk. So, promising results in terms of therapeutic efficacy and reliability make desirable the wide clinical use of
denosumab for the treatment of
osteoporotic fractures in the near future.